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This form must be submitted for all Welding Inspector and Radiographic Interpreter applications. Applicants for the Certified Welding
Educator are not required to complete this form.
AWS will not release exam results, recertification results, or renewals without a completed Visual Acuity Record on file.
IMPORTANT: This completed eye examination form must be sent to the AWS Certification Department prior to the exam, submitted on
the day of the exam to the Test Supervisor, or sent to the AWS Certification Department no later than 30 days after the certification
exam date via fax, email or mail. Applicants who have not fulfilled all requirements within 30 days after the certification exam date shall
have all records, scores and applications voided and may be in jeopardy of forfeiting application fees.
Eye Examination
Eye examinations shall be administered by an Ophthalmologist, Optometrist, Medical Doctor, Registered Nurse or Certified Physicians
Assistant or by other ophthalmic medical personnel, and must include the state or province license number. Examinations shall be
performed not more than 7 months prior to the date of the welding inspector examination or recertification.
All applicants must pass an eye examination, with or without corrective lenses, to prove near vision acuity on Jaeger J2 at 12 in. or greater
(30.5 cm). All applicants shall take a color perception test. Eye examination results must be documented on this visual acuity form
supplied by the AWS Certification Department. No other forms will be accepted.
Must be completed by the eye examiner
1. Verify the customers close vision acuity to Jaeger J2 specifications at a distance of 12 inches or greater(30.5 cm)
(Check ONLY one of the following for each eye)
OD
OS
NQ
AWS
Use
Only
AWS
Use
Only
OS
Customer IS colorblind.
Examiner name
Telephone number
Optometrist
Medical Doctor
Registered Nurse